Implementation of a Self-Measured Blood Pressure Pilot Program in an Academic Internal Medicine Practice.

Abstract

Background: Self-measured blood pressure (SMBP) monitoring is a proposed strategy to improve hypertension control, but few studies compare SMBP with automated office blood pressure (AOBP) measurements over time. Moreover, little is known about reimbursement for these services.

Methods: We describe a quality improvement initiative in our academic internal medicine practice. Patients received validated home blood pressure (BP) devices and were instructed to check their BP twice daily for 7 days each month. Devices transmitted readings seamlessly via a smartphone application that averaged weekly readings. Clinicians reviewed the data and adjusted therapy if indicated. We tracked changes in SMBP, AOBP, antihypertensive medications, and reimbursement.

Results: Among 140 patients referred (mean age 57.6 years, 57.1% women, 25.7% Black), 59 completed the program. Over 6 months, the mean self-measured systolic BP decreased by 5.8 mm Hg (95% CI: -8.2 to -3.5) and the mean diastolic BP decreased by 2.8 mm Hg (95% CI: -4.2 to -1.4) and the number with BP <130/<80 mm Hg increased by 22 percentage points (P = 0.007). However, unattended AOBP showed no change in either systolic (change: 0.1 mm Hg; P = 0.98) or diastolic (change: -0.6 mm Hg; P = 0.64) readings. Reimbursement was variable and ranged from no payment to a maximum payment of $51; when paid, the average payment was $13.81.

Conclusions: In this program, SMBP decreased over time while AOBP remained similar. Reimbursement, when received, was modest. Future work should evaluate whether using SMBP as a therapeutic target reduces cardiovascular events.